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Year 2 Revision > Endocrinology Investigation and Management > Flashcards

Endocrinology Investigation and Management Flashcards

1
Q

Investigations for hypothyroid disease

A

Thyroid function tests

Anti-TPO antibody

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2
Q

Hypothyroid management

A

Start levothyroxine at 25-50 micrograms daily.
Adjust dose every 4 weeks according to response.
Check TSH 2 months after any dose change.

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3
Q

Myxoedema coma management

A 
ABCDE
Passively rewarm
Cardiac monitoring for arrhythmias
Monitor UO, fluid balance, CVP, blood sugar, oxygenation. 
Broad spectrum antibiotics.
Thyroxine and hydrocortisone.
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4
Q

Hyperthyroid investigations

A

Thyroid function tests
TRAb
Scintigraphy if antibody negative or suspected nodular disease.
Potentially thyroid ultrasound for nodule.

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5
Q

Thyroid storm management

A 
Lugol's iodine
Glucocorticoids
PTU
B-blockers
Fluids
Monitoring
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6
Q

Hyperthyroid management

A
  1. Medication: carbimazole (propylthiouracil in 1st trimester) and beta blockers for symptomatic relief.
  2. Radioiodine.
  3. Thyroidectomy.
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7
Q

Thyroid cancer investigations.

A

Ultrasound guided FNA

Maybe excision biopsy of lymph node

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8
Q

Management for papillary microcarcinoma, minimally invasive follicular carcinoma with capsular invasion only or AMES low risk?

A

Thyroid lobectomy with isthmusectomy.

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9
Q

Management for thyroid cancer with extra-thyroidal spread, mets, nodal involement or AMES high risk.

A

Sub-total or total thyroidectomy.

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10
Q

Investigation after sub-total or total thyroidectomy

A

Whole body iodine scanning.

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11
Q

Thyroid mets management

A

Thyroid remnant ablation (given radioactive iodine).

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12
Q

Investigations for hypercalcaemia of malignancy

A

Raised calcium and ALP
X-ray, CT, MRI
Isotope bone scan

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13
Q

Hypercalcaemia acute management

A

Rehydration with saline
Consider loop diuretics once rehydrated
Bisphosponates
Steroids occasionally used.

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14
Q

Investigation after diagnosis of primary hyperparathyroidism

A

Setamibi scan

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15
Q

Primary hyperparathyroidism management

A

Surgery

Cinacalcet (calcium mimetic, useful if unfit for surgery)

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16
Q

Indications for parathyroidectomy

A

End organ damage (bones, gastric ulcers, renal stones, osteoporosis)
Very high calcium
Under 50
eGFR <60ml/min

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17
Q

Familial hypocalciuric hypercalcaemia management

A

Nothing, it will not cause any problems

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18
Q

Acute hypocalcaemia management

A

Emergency: IV calcium gluconate

Calcium gluconate infusion.

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19
Q

Hypoparathyroidism long term management

A

Calcium supplement

Vit D supplement (alphacalcidol)

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20
Q

Pseudohypoparathyroidism biochemical findings

A

Low calcium

PTH elevated

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21
Q

Pseudohypoparathyroidism management

A

Same as primary hypoparathyroidism

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22
Q

Chronic rickets/osteomalacia treatment

A

Vitamin D3 tablet (calcitriol, alfacalcidol)

Combined calcium and vit D.

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23
Q

Vit D resistant rickets treatment

A

Phosphate and vit D supplements

Maybe surgery

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24
Q

Adrenal insufficiency investigations

A 
Biochemisty
Short synacthen test!!!
ACTH levels
Renin/aldosterone levels
Adrenal autoantibodies
Imaging
25
Q

Primary adrenal insufficiency management

A

Hydrocortisone as cortisol replacement
Fludrocortisone as aldosterone replacement

Remember sick day rules

26
Q

Secondary adrenal insufficiency management

A

Hydrocortisone replacement

fludrocortisone unnecessary

27
Q

Cushings screening tests

A

Overnight dexamethasone suppression test
24 hour urinary free cortisol
Late night salivary cortisol

28
Q

Gold standard cushings test

A

Low dose dexamethasone suppression test

Repeat to confirm

29
Q

Primary aldosteronism investigation

A 
Biochemical testing (high sodium, low potassium)
Plasma aldosterone renin ratio
Saline suppression test (2 litres of saline normally suppresses aldosterone by over 50%)
Adrenal CT (adenoma)
Sometimes adrenal vein sampling to determine whether adenoma or bilateral adrenal hyperplasia
30
Q

Management of Conn’s adenoma (primary aldosteronism).

A

Unilateral laparoscopic adrenalectomy.

31
Q

Management of bilateral adrenal hyperplasia.

A

Mineralocorticoid receptor antagonists (spironolactone, eplerenone).

32
Q

Congenital adrenal hyperplasia investigation.

A

Basal or stimulated 17-OH progesterone (raised)

Can do genetic mutation analysis

33
Q

CAH management

A 
Glucocorticoid replacement
Mineralocorticoid replacement in some
Surgical correction
Achieve maximal growth potential
Control androgen excess
Restore fertility
34
Q

Phaeochromocytoma investigation

A

Urine - 24 hours catecholamines/metanephrines
Plasma - catecholamines/metanephrins ideally at time of symptoms
MRI scan
MIBG scan
PET scan

35
Q

Phaeochromocytoma management

A

Alpha blocker (phenoxybenzamine), then beta blocker.
Fluid and/or blood replacement
Careful anaesthetic assessment
Laparscopic excision (or de-bulking)
Chemotherapy if malignant (radio-labelled MIBG).

36
Q

Prolactinoma investigations

A

Raised serum prolactin
MRI pituitary
Pituitary function tests
Visual fields

37
Q

Prolactinoma management

A

Dopamine agonists (cabergoline, bromocriptine)

38
Q

Acromegaly investigations

A 
IGF-1 (age+sex matched)
Glucose tolerance test (measure GH after glucose)
MRI pituitary
Visual fields
Pituitary function testing
39
Q

Acromegaly management

A
  1. Pituitary surgery then retest GTT.
  2. Somatostatin analogues (lanreotide, octreotide).
  3. Dopamine agonists (cabergoline)
  4. GH antagonist (pegvisomant, last line, expensive)
40
Q

Cushings disease (pituitary disease) specific investigation.

A

CRH test (stimulation test).

41
Q

Cushings disease (pituitary disease) management.

A
  1. Hypophysectomy
  2. External radiotherapy if recurs.
  3. Bilateral adrenalectomy.
42
Q

Cushings syndrome adrenal cause management.

A

Adrenalectomy

43
Q

Cushings syndrome ectopic source management.

A
  1. Remove source.

2. Bilateral adrenalectomy.

44
Q

Cushings medical treatment.

A
  1. Metyrapone.
  2. Ketoconazole (hepatotoxic)
  3. Pasireotide
45
Q

Pan hypopituitarism investigations.

A

Pituitary function tests.

46
Q

Osteoporosis investigation

A

DEXA scan looking for bone mineral density.

47
Q

Who is referred for osteoporosis investigation

A

Patients over 50 with low trauma fracture
Patients at increased risk of fracture based on risk factors calculated using risk assessment tool
Anyone with a 10 year risk assessment for any OP fracture of at least 10%

48
Q

Osteoporosis lifestyle management

A 
High intensity strength training
Low-impact weight-bearing exercise
Avoidance of excess alcohol
Avoidance of smoking
Fall prevention
49
Q

Osteoporosis management

A

Vit D and Ca supplements
Bisphosphonates (alendronate, risedronate)
Zoledronic acid (once yearly IV infusion)
Denosumab (6 monthly SC injection)
Teriparatide

50
Q

When to treat in osteoporosis

A

Consider antiresorptive therapy when T-score < -2.5

If ongoing steroid use (3 months or more) or vertebral fracture, then when T score

51
Q

Paget’s disease management

A

Bisphosphonates if pain not responding to analgesia.

52
Q

Osteogenesis imperfecta management

A

Fracture fixation
Surgery to correct deformities
Bisphosphonates

53
Q

T1 and T2 diabetes in pregnancy management

A

Pre-pregnancy counselling (good sugar control)
Folic acid 5mg
Consider change from tablets to insulin
Regular eye checks (due to accelerated retinopathy)
Use b-blocker, calcium channel blocker or methyldopa for blood pressure (avoid ACEI and statin)

54
Q

Hypothyroidism in pregnancy management

A

Increase thyroxine by 25mcg as soon as pregnancy suspected
Check TFTs months for first 20 weeks then every 2 months
Aim for TSH <3

55
Q

Investigation for hyperemesis gravidarum (to distinguish from hyperthyroid)

A

hCG (increased)
TSH (decreased)
TRab (negative)
Improves by 20 weeks gestation

56
Q

Hyperthyroidism in pregnancy management

A

B-blockers if needed
Low dose anti-thyroid drugs (PTU 1st trimester, carbimazole 2/3rd)
Wait as late as possible before starting anti-thyroid drugs

57
Q

Post-partum thyroiditis

A

Don’t treat in hyperthyroid stage

Do treat in hypothyroid stage

58
Q

Thyroid nodule initial investigation and second line investigation

A

Thyroid function tests

US guided FNA

Year 2 Revision (45 decks)

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